Detection of extracardiac stimulation by a cardiac rhythm management device

1. A method for controlling a cardiac rhythm management therapy, comprising:

delivering a cardiac pacing pulse;

acquiring a cardiac electrical signal comprising myocardial depolarization and repolarization signals; and

enabling a processor to, responsive to the cardiac electrical signal, detect extracardiac capture due to the cardiac pacing pulse, the method further comprising:

acquiring the cardiac signal for a plurality of paced cardiac cycles;

averaging the cardiac signals acquired for the plurality of paced cardiac cycles to obtain an averaged signal; and

detecting the extracardiac capture from the averaged signal.

2. The method of claim 1 , further comprising

establishing a cardiac signal template comprising no extracardiac stimulation; and

detecting the extracardiac capture from a difference between the averaged signal and the template.

3. The method of claim 1 , further comprising:

sensing a respiration signal; and

gating the cardiac electrical signal according to a phase of the respiration signal.

4. The method of claim 1 , further comprising adjusting a parameter controlling the pacing pulse in response to detecting the extracardiac stimulation.

5. The method of claim 4 , wherein the parameter comprises one of a timing parameter and an electrode selection parameter.

6. The method of claim 1 , further comprising generating an alert notification in response to detecting the extracardiac stimulation.

7. An implantable medical device system for delivering a cardiac rhythm management therapy, comprising:

a signal generator to deliver cardiac pacing pulses;

a sensing module to acquire a cardiac electrical signal comprising myocardial depolarization and repolarization signals; and

a processor configured to, responsive to the cardiac electrical signal, detect extracardiac capture due to a cardiac pacing pulse, wherein the sensing module is configured to acquire the cardiac signal for a plurality of paced cardiac cycles, and

the processor is configured to average the cardiac signals acquired for the plurality of paced cardiac cycles to obtain an averaged signal and detect the extracardiac capture from the averaged signal.

8. The system of claim 7 , wherein the processor is further configured to determine a cardiac signal template comprising no extracardiac stimulation, and detect the extracardiac capture from a difference between the averaged signal and the template.

9. The system of claim 7 , wherein the sensing module is further configured to sense a respiration signal; and

the processor is configured to gate the cardiac electrical signal according to a phase of the respiration signal.

10. The system of claim 7 , wherein the processor is configured to adjust a parameter controlling the pacing pulses delivered by the signal generator in response to detecting the extracardiac stimulation.

11. The system of claim 10 , wherein the parameter comprises one of a timing parameter and an electrode selection parameter.

12. The system of claim 7 , further comprising a communication module to generate an alert notification in response to the processor detecting the extracardiac stimulation.

13. A non-transitory computer-readable medium storing a set of instructions which when implemented in an implantable medical device system cause the system to perform a method for controlling a cardiac rhythm management therapy, the method comprising:

delivering a cardiac pacing pulse;

acquiring a cardiac electrical signal comprising myocardial depolarization and repolarization signals; and

enabling a processor to, responsive to the cardiac electrical signal, detect extracardiac capture due to the cardiac pacing pulse, the method further comprising:

acquiring the cardiac signal for a plurality of paced cardiac cycles;

averaging the cardiac signals acquired for the plurality of paced cardiac cycles to obtain an averaged signal; and

detecting the extracardiac capture from the averaged signal.